TYPHOUS AND VAEIOLOUS ULCERS OF THE LARYNX. 33 



great diagnostic importance. Experience teaches that follicular ulcers 

 of the larynx are often combined with follicular pharyngeal ulceration. 

 If, then, in: patients with long-standing hoarseness and other symptoms 

 of chronic laryngeal catarrh, we find a reddening of the mucous mem- 

 brane of the soft palate, and see the posterior pharyngeal wall studded 

 with small round, yellowish sores, it is to be presumed that the disease 

 has also invaded the larynx. 



The majority of laryngeal ulcers may be brought into view by means 

 of the laryngoscope, especially when situated upon the epiglottis, upon 

 the arytenoid cartilages, on the aryepiglottic folds, and upon the true 

 and false vocal chords. 



TREATMENT. The treatment of catarrhal ulceration of the larynx is 

 almost identical with that of the simple laryngeal catarrh ; and, as in 

 catarrh of other mucous membranes, we do not materially modify our 

 treatment where ulceration supervenes upon simple inflammation. It 

 cannot, however, be denied that the cure of catarrhal ulcers of the larynx 

 takes place somewhat more rapidly when the medicaments are applied 

 directly and solely to the sore itself, instead of over the whole mucous 

 surface. Whoever has obtained sufficient laryngoscopic dexterity to 

 enable him to touch the ulcers with lunar caustic in substance, or with a 

 concentrated solution of nitrate of silver, will do well to adopt such 

 local treatment, instead of that recommended in the last chapter, espe- 

 cially instead of inhalation of alum or nitrate of silver in solution. While 

 practising local treatment, however, whether by cautery or inhalation, 

 the dietetic and other internal treatment already described is not to be 

 neglected. The partiality to which specialists are so often prone is not 

 only hurtful to the patient, but injures the credit of new therapeutic 

 measures. When a chronic ulcer of the larynx, which has long resisted 

 a regular course of caustic at the hands of a specialist, recovers under 

 the use of Ems-water and careful nursing of the mucous membrane, 

 perhaps after weeks of absolute enforced silence, it will generally be 

 found that the patient had relied solely upon the local treatment for a 

 cure, and had lived imprudently or absurdly. 



CHAPTER IV. 



TYPHOUS AND VAEIOLOUS ULCEES OF THE LARYNX. 



ETIOLOGY. If rom the teaching of Rokitansky, the belief has long 

 prevailed that typhous ulceration of the larynx proceeded from " me- 

 dullary infiltration of the mucous glands of the larynx with subsequent 

 sloughing," and was therefore quite analogous to the intestinal ulcers 

 ot typhus, which are formed by the action of a similar morbid process 

 upon the solitary glands and the glands of Peyer. 

 4 



